中国循证医学杂志

中国循证医学杂志

中国肝癌及相关疾病状态健康效用值及失能权重研究的系统评价

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目的 系统评价中国人群肝癌及相关疾病研究的健康效用值及失能权重值。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、WanFang Data、CBM 和 VIP 数据库,搜集有关中国人群肝癌及相关疾病健康效用值及失能权重值的研究,检索时限从建库至 2017 年 11 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 Stata 12.0 软件进行 Meta 分析。 结果 最终纳入 9 个研究,涵盖 10 余种肝癌相关疾病状态,以慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化及肝癌最多见。文献质量整体尚可,最多使用 EQ-5D 工具测量健康效用值。Meta 分析结果显示:慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化和肝癌的合计健康效用值均值及 95%CI 为 0.789(0.735,0.843)、0.734(0.693,0.776)、0.647(0.627,0.666)和 0.636(0.508,0.765)。其中应用 EQ-5D 量表的慢性乙型肝炎、代偿期肝硬化、失代偿期肝硬化和肝癌的健康效用值为 0.815(0.762,0.868)、0.761(0.731,0.791)、0.643(0.62,0.666)和 0.62(0.473,0.766)。此外,描述性分析所得效用值均值中位数(范围)分别为 0.758(0.520~0.950)、0.716(0.570~0.900)、0.538(0.260~0.662)和 0.541(0.310~0.720)。失能权重研究仅有 1 个,失能权重值为 0.36~0.90。 结论 中国人群肝癌相关健康效用研究较少,尤其是失能权重研究。Meta 分析结果比描述性分析所得健康效用值更高且集中。量表间结果有差异,使用时应注意。此外,健康效用值随疾病加重而降低,提示早预防、早诊治可能挽救更多有生活质量的生命年。

Objective To systematic review the health utility scores and disability weights of liver cancer and related diseases in China. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software. Results A total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was fine, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789 (0.735, 0.843), 0.734 (0.693, 0.776), 0.647 (0.627, 0.666) and 0.636 (0.508, 0.765), respectively. Measures from EQ-5D were 0.815 (0.762, 0.868), 0.761 (0.731, 0.791), 0.643 (0.62, 0.666) and 0.62 (0.473, 0.766), respectively. In addition, the corresponding median (range) utility scores of the four diseases were found to be 0.758 (0.520–0.950), 0.716 (0.570–0.900), 0.538 (0.260–0.662) and 0.541(0.310–0.720). Only one disability weight study was concluded (0.36–0.90 reported for liver cancer). Conclusion In Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and more centralized than those from descriptive analysis. Different survey tools bring out various outcomes, and attentions should be paid to their application. Health utility scores decrease with the severity of liver disease, which suggests that early prevention, early diagnosis and treatment might can save more life years with better quality.

关键词: 肝癌; 相关疾病; 健康效用值; 失能权重; 系统评价; 中国

Key words: Liver cancer; Related diseases; Health utility score; Disability weights; Systematic review; China

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